Individual Member Joining Form | European Association for Palliative Care

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Your Details

First Name *

Last Name *

Email Address *

How do you identify? *

City *

Country *

What age range are you in?

Your Ethnicity? *

Tell us how you describe yourself

Your work details

What best describes you? *

Job Title *

How long have you worked in Palliative Care? *

Which organization do you work for? *

Profession *

Secondary Profession

Area of Interest

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Are you a member of a National Palliative Care Association?

EAPC Reference Groups and Task Forces

I am a member of

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I would like to join

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Is your billing address the same as your address above?

Yes

Billing Details

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City 2

Postal Code 2

Country 2

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